The knee joint houses two C-shaped cushions called menisci. Each meniscus attaches on the outside or inside portions of the lower leg bone, or tibia. The menisci help prevent side-to-side movement and absorb shock transmitted to the knee joint. Knee tests assess abnormal side-to-side movement and pain when pressure is applied. The exact accuracy of each test is not well documented but largely depends on the expertise of the health care professional who interprets the results. Imaging methods show obvious tears while other clinical tests look for clicking sounds, restriction of movement or tenderness and pain. With the exception of the MRI, the "Journal of Family Practice" and the "Journal of Bone and Joint Surgery" report significant differences in opinion about the value and accuracy of clinical tests when using them in isolation to determine a meniscal tear.
The Joint-Line Tenderness Test
The joint-line tenderness test will most likely be the first step in any meniscal assessment. A health care professional will check for pain by gently applying pressure to the knee joint area where the upper leg bone (the femur) and the lower leg bone (the tibia) meet. Obviously, pain may be an indication of a torn meniscus. This test serves primarily as the initial inspection to verify if, or what other tests may be needed.
The McMurray Test
In the McMurray test, with the patient lying on his back, the health care professional holds the patient's knee joint and foot while flexing and extending the patient's knee. Depending on the meniscus being assessed (inside or outside), the foot and knee are rotated slightly outward or inward during the back-and-forth movements. A "clicking" sound or pain during the movement indicates a meniscal tear.
The Apley CompressionTest
The Apley compression test requires the patient to lie face down and lift the lower leg to form a 90 degree angle with the upper leg. The physician then places a downward pressure on the lower leg and rotates the foot outward and inward. Clicking sounds, pain and decreased range of motion serve as positive indicators for a torn meniscus. A person who suspects he has a meniscal tear should seek professional medical care. Attempting one of the assessments with an untrained professional could result in further injury.
Magnetic Resonance Imaging (MRI)
Still considered the "gold standard," MRI uses magnetic waves to collect detailed images of the injured area. Because meniscal tears commonly occur along with other knee injuries, the MRI also provides sufficient information to help determine whether any additional damage has been done to the knee joint. Although costly, physicians still prefer this method as a definitive test for its accuracy.
X-ray
An X-ray may also be used but does not provide enough information alone to definitively diagnose a meniscal tear. However, it may provide key information in determining other possible sources of knee pain such as osteoarthritis, according to the American Academy of Orthopaedic Surgeons. This may help the health care professional determine the best method of treatment or include additional treatments to prevent further knee pain.
